Charles W. Acher, MD, Martha M. Wynn, MD, John R. Hoch, MD, Paul W

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Presentation transcript:

Cardiac function is a risk factor for paralysis in thoracoabdominal aortic replacement Charles W. Acher, MD, Martha M. Wynn, MD, John R. Hoch, MD, Paul W. Kranner, MD Journal of Vascular Surgery Volume 27, Issue 5, Pages 821-830 (May 1998) DOI: 10.1016/S0741-5214(98)70261-7 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Regression plot for preoperative and postoperative serum creatinine levels (mg/dl). The only significant predictor of the postoperative creatinine level was the preoperative creatinine level (p < 0.0001). With the slope of the regression line used as a measure of renal function before and after aneurysm repair, patients with renal revascularization had improved renal function (slope = 0.55) compared with patients who did not (slope = 0.91). Journal of Vascular Surgery 1998 27, 821-830DOI: (10.1016/S0741-5214(98)70261-7) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Plot of the cardiac index (CI) before (CI1), during (CI2), and after (CI3) aortic occlusion in patients with and without deficits. The change in CI with aortic occlusion (delta CI) was a significant factor for paraplegia risk and may reflect the heart's ability to augment collateral blood flow to the spinal cord. Journal of Vascular Surgery 1998 27, 821-830DOI: (10.1016/S0741-5214(98)70261-7) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Paraplegia risk by technique of repair. In the regression plot of predicted versus actual number of deficits, the slope is an estimate of the paraplegia risk of that technique of repair, which is predictable and stable over time. Graft inclusion and intercostal reimplantation with or without assisted circulation had identical and perfectly predictable (slope = 0.98) paraplegia risks. XCLMP, cross clamp; AFB, assisted circulation; CSFD, cerebrospinal fluid drainage; GROUP A, patients who received CSFD and low-dose naloxone (1 μg/kg/hour) as adjuncts to reduce the risk of paralysis. Journal of Vascular Surgery 1998 27, 821-830DOI: (10.1016/S0741-5214(98)70261-7) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions